Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing

Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective in the workplace.     

A retrospective benefit-cost analysis of the 1997 stair-fall requirements for baby walkers

Based on estimates from the U.S. Consumer Product Safety Commission (CPSC), there were about 25,000 baby walker-related injuries treated annually in U.S. hospital emergency departments during the early 1990s. This amounted to about 8 injuries for every 1000 baby walkers in use. Most injuries resulted from falls down stairs. After CPSC initiated a regulatory proceeding in 1994, the CPSC staff worked with industry to address the stair-fall hazard. This cooperative effort resulted in requirements designed to prevent stair-fall injuries that became effective in 1997 as part of a revised voluntary safety standard. This study presents a retrospective benefit-cost analysis of the 1997 stair-fall requirements. The benefits were defined as the reduction in the costs of injuries resulting from the use of the safer walkers. The costs were defined as the additional resource costs associated with making baby walkers safer. The study found that the stair-fall requirements were highly effective in reducing the risk of stair-fall injury, and that the benefits of the requirements substantially exceeded the costs. The expected net benefits (i.e., benefits minus costs) amounted to an average of about $169 per walker, over the walker's expected product life. Given current U.S. sales of about 600,000 baby walkers annually, the present value of the expected net benefits associated with 1 year's production amounts to over $100 million annually. A sensitivity analysis showed that the major findings were robust with respect to variations in underlying assumptions.     

Costs of occupational injuries in construction in the United States

This paper presents costs of fatal and nonfatal injuries for the construction industry using 2002 national incidence data from the Bureau of Labor Statistics and a comprehensive cost model that includes direct medical costs, indirect losses in wage and household productivity, as well as an estimate of the quality of life costs due to injury. Costs are presented at the three-digit industry level, by worker characteristics, and by detailed source and event of injury. The total costs of fatal and nonfatal injuries in the construction industry were estimated at $11.5 billion in 2002, 15% of the costs for all private industry. The average cost per case of fatal or nonfatal injury is $27,000 in construction, almost double the per-case cost of $15,000 for all industry in 2002. Five industries accounted for over half the industry's total fatal and nonfatal injury costs. They were miscellaneous special trade contractors (SIC 179), followed by plumbing, heating and air-conditioning (SIC 171), electrical work (SIC 173), heavy construction except highway (SIC 162), and residential building construction (SIC 152), each with over $1 billion in costs.     

Estimation of the social costs of home injury: a comparison with estimates for road injury

Home injury is thought to constitute a major health burden in most developed countries. However, efforts to address this burden have been hampered by reluctance from outside agencies to interfere with the home environment of individuals, even if it benefits the occupant's safety. This paper outlines cost–benefit evaluation methods established in the transport safety domain applied to home safety to estimate the social cost of unintentional home injury in New Zealand. Estimates of costs imposed on society by home injury can provide an important motivator for initiating research and programmes to reduce home injury risk. Data sources used included mortality data, hospitalisation data and data on minor injuries that required medical treatment, but not hospital admission. We estimated that unintentional home injuries in New Zealand impose an annual social cost of about $NZ 13 billion (about $US 9 billion), which is about 3.5 times the annual social cost of road injury. These estimates provide a rational evidence base for decisions on housing-focused safety regulation or interventions that always carry some cost, and therefore need to be weighed against the benefits of injuries potentially prevented.     

Crash costs by body part injured, fracture involvement, and threat-to-life severity. United States, 2000

This paper presents costs per US motor vehicle crash victim differentiated into many more diagnostic categories than prior estimates. These unit costs, which include the first keyed to the 1990 edition of Abbreviated Injury Scale (AIS) threat-to-life severity scores, are reported by body part, whether a fracture/dislocation was involved, and the maximum AIS score among the victim's injuries. This level of detail allows for a more accurate estimation of the social costs of motor vehicle crashes. It also allows for reliable analyses of interventions targeting narrow ranges of injuries. The paper updates the medical care data underlying the US crash costs from 1979 to 1986 to the mid 1990s and improves on prior productivity cost estimates. In addition to presenting the latest generation of crash victim costs, this paper analyzes the effects of applying injury costs classified by AIS code from the 1985 edition to injury incidence data coded with the 1990 edition of AIS. This long-standing practice results in inaccurate cost-benefit analyses that typically overestimate benefits. This problem is more acute when old published costs adjusted for inflation are used rather than the recent costs.     

Crash costs in the United States by crash geometry

MAIN OBJECTIVES: This study was conducted to estimate the costs per crash for three police-coded crash severity groupings within 16 selected crash geometry types and within two speed limit categories (or=50 mph). METHODS: We merged previously developed costs per victim by abbreviated injury scale (AIS) score into U.S. crash data files that scored injuries in both the AIS and police-coded severity scales to estimate injury costs, then aggregated the estimates into costs per crash by maximum injury severity. RESULTS: The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 US dollars and 1.16 million US dollars per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs. CONCLUSIONS: This paper provides cost estimates useful for evaluating roadway countermeasures and for designing vehicles to minimize crash harm. It gives unit costs of crashes by type in the coding system used by the police. The costs are in an appropriate form for economic analysis of countermeasures addressing locally defined problems identified by analyzing police crash reports.     

The economic burden of injury: Health care and productivity costs of injuries in the Netherlands

BackgroundDetailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex.MethodInjury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model.ResultsTotal costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15–54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15–24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient.ConclusionOur detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention.     

Crash costs and safety investment

Injury crashes cost society more than $34 billion annually. Expending up to $2.3 million to prevent one fatal crash appears to be rational public policy, although the crash costs society only $500,000. Prevention of severe, nonfatal head and spinal cord injuries warrants even larger expenditures. The estimated rational investment to prevent an average nonfatal injury crash is $22,000, while society's cost is $8,000. Rational investment levels for increased safety are estimated by summing the amount individuals typically pay for small increases in their safety and the cost the rest of society bears when someone is killed or injured, including transfer payments.     

Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands

The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies.Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model.Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (−4%) for all injuries, showing a strong decrease in children (−36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0–24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15–64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged 55+) were identified as main risk group for TBI, as they had highest ED attendance, injury rate, injury severity, admission to hospital or intensive care unit, and costs.Incidence of ED treatments due to cycling are high and often involve TBI, imposing a high burden on individuals and society. Older cyclists aged 55+ were identified as main risk group for TBI to be targeted in preventive strategies, due to their high risk for (serious) injuries and ever-increasing share of ED visits and hospital admissions.     

Costs of alcohol-related crashes: New Zealand estimates and suggested measures for use internationally

This paper presents policy-oriented measures of alcohol-related crash incidence and costs in New Zealand (N.Z.). Costs of crashes, where alcohol probably was a contributing factor were computed from official crash costs and police-reported crash/injury counts adjusted for under-reporting of crashes and of alcohol involvement. Alcohol-related crashes cost an estimated $1.2 billion in N.Z. in 1996. They equate to an estimated $0.75 per drink consumed, $17.80 per km driven above the legal limit of 0.08, and $1100 per heavy drinker. People other than the drinkers, who caused the crashes, paid half the costs. An estimated one in 90 drunk-driving trips resulted in a crash (and often a drunk driving conviction) while one in 375 crash-free drunk driving trips also resulted in a drunk-driving conviction. Ten measures of alcohol-related crash incidence and costs are recommended for international use. They include number of alcohol-related deaths and injuries; innocent victims and children harmed in crashes caused by drinkers; annual costs and costs paid by people other than the drinker who caused the crash; crash costs per drink consumed, per heavy drinker, per kilometer driven drunk versus sober; probabilities of crash and of drunk-driving conviction.     

Water recreation-related spinal injuries: risk factors in natural bodies of water

Spinal cord injuries are a major public health problem, and costs to society may total $6.2 billion per year. Using a case-control design, we investigated risk factors for spinal injury in male Wisconsin residents who sustained their injuries during water recreational activity. Compared with the controls, the people who sustained spinal injury were more likely to have entered the water from a pier or dock; to have dived into water; and to have used alcohol. Injury prevention programs for water recreation enthusiasts should address the topics of the hazards of combining alcohol with these activities, how to enter natural bodies of water safely, and safe water levels for diving.     

Factors affecting hospital charges and length of stay from teenage motor vehicle crash-related hospitalizations among United States teenagers, 2002-2007

Motor vehicle crashes are the leading cause of death for all teenagers, and each year a far greater number of teens are hospitalized with non-fatal injuries. This retrospective cohort study used the National Inpatient Sample data to examine hospitalizations from the years 2002 to 2007 for 15–18-year-old teenagers who had been admitted due to a motor vehicle crash. More than 23,000 teens were hospitalized for motor vehicle-related crash injuries each year, for a total of 139,880 over the 6-year period. Total hospital charges exceeded $1 billion almost every year, with a median hospital charge of more than $25,000. Older teens, boys, those with fractures, internal injuries or intracranial injuries, and Medicaid/Medicare as a payer were associated with higher hospital charges and longer lengths of stay. These high charges and hospitalization periods pose a significant burden on teens, their families, and the health care system.     

Causes of nonfatal injuries in the United States, 1986

During the 1986 National Health Interview Survey (NHIS), data on injuries resulting in a doctor visit or restricted activity for at least a half day were collected and assigned E-codes. Based on 603 injuries, the estimated number of nonfatal injuries for civilian, noninstitutionalized U.S. residents in 1986 was 60,212,000. The most frequent cause of injury was a fall (11,547,000), followed by motor vehicle traffic crashes (4,361,000) and adverse effects of drugs and biologies (3,363,000). While cause-specific detail was limited by small numbers of injuries in the sample, the NHIS can provide a valuable snapshot of the causes of nonfatal injuries.     

A comparison of workplace safety perceptions among financial decision-makers of medium- vs. large-size companies

This study, through a random national survey in the U.S., explored how corporate financial decision-makers perceive important workplace safety issues as a function of the size of the company for which they worked (medium- vs. large-size companies). Telephone surveys were conducted with 404 U.S. corporate financial decision-makers: 203 from medium-size companies and 201 from large companies. Results showed that the patterns of responding for participants from medium- and large-size companies were somewhat similar. The top-rated safety priorities in resource allocation reported by participants from both groups were overexertion, repetitive motion, and bodily reaction. They believed that there were direct and indirect costs associated with workplace injuries and for every dollar spent improving workplace safety, more than four dollars would be returned. They perceived the top benefits of an effective safety program to be predominately financial in nature – increased productivity and reduced costs – and the safety modification participants mentioned most often was to have more/better safety-focused training. However, more participants from large- than medium-size companies reported that “falling on the same level” was the major cause of workers’ compensation loss, which is in line with industry loss data. Participants from large companies were more likely to see their safety programs as better than those of other companies in their industries, and those of medium-size companies were more likely to mention that there were no improvements needed for their companies.     

Work-related ladder fall fractures: identification and diagnosis validation using narrative text

OBJECTIVE: To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries. METHODS: Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios. RESULTS: Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures. CONCLUSIONS: Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.     

The burden of injuries in the Philippines: implications for national research policy

Injuries cause 10% of the mortality and 15% of disability worldwide. However, there is a paucity of data on injuries in the developing world where two-thirds of all injury deaths occur. This is the first published report characterizing the overall problem of injuries in the Philippines, a developing country in southeast Asia. This report defines the burden of injuries in the Philippines and identifies priority areas for the national health research agenda. A systematic review of 35 years of published and unpublished data on injuries in the Philippines (1960–1995) was conducted. Injury fatality rates increased by 196% from 14.3 per 100,000 in 1960 to 42.3 per 100,000 in 1995, and one in 11 deaths in the Philippines are due to injuries. Intentional injuries account for 48% of all injury deaths and motor vehicle crashes for 15%. For 15–44 year old males, injuries account for 42% of all deaths, 67% of which are intentional. The proportion of all deaths attributable to intentional injuries has increased by 925% and that of motor vehicle crashes by 600% from 1960 to 1995. Improvements in injury surveillance and documentation of non-fatal injury outcomes are needed. Research into risk factors and potential interventions for the prevention of intentional injuries should be a priority in the Philippines.     

Head injuries in lateral impact collisions

Individual non-minor injuries (Abbreviated Injury Scale (AIS) ≥ 2) to the head that occurred to belted and unbelted drivers and front seat passengers on the struck side of impacted vehicles were examined. Injury type, injury combination, collision severity in relation to type of injury as well as contact sources were assessed. Forty-eight percent of injuries were moderate in severity (AIS 2). The most common type of injury was the diffuse brain injury, typically marked by a short period of unconsciousness, which occurred in collisions of lower severity than focal brain and skull fracture injuries. One-hundred and five out of 216 (48.6%) of contact sources for all injury types originated from outside the vehicle and such exterior sources were more likely to result in high severity injuries. Thirty percent of injuries resulted from head contacts with other vehicles. The most frequent vehicle interior contact source was the side window glass. Diffuse injuries tended to occur independently of other injury types and were more likely to originate from an interior rather than exterior contact. Preventative measures for head injury reduction in lateral collisions are discussed. Overall, the data show that proposed and present European and U.S. lateral impact test methods do not address many head injury problems such as those included in this study.     

A Bayesian hierarchical model for accident and injury surveillance

This article presents a recent study which applies Bayesian hierarchical methodology to model and analyse accident and injury surveillance data. A hierarchical Poisson random effects spatio-temporal model is introduced and an analysis of inter-regional variations and regional trends in hospitalisations due to motor vehicle accident injuries to boys aged 0-24 in the province of British Columbia, Canada, is presented. The objective of this article is to illustrate how the modelling technique can be implemented as part of an accident and injury surveillance and prevention system where transportation and/or health authorities may routinely examine accidents, injuries, and hospitalisations to target high-risk regions for prevention programs, to evaluate prevention strategies, and to assist in health planning and resource allocation. The innovation of the methodology is its ability to uncover and highlight important underlying structure of the data. Between 1987 and 1996, British Columbia hospital separation registry registered 10,599 motor vehicle traffic injury related hospitalisations among boys aged 0-24 who resided in British Columbia, of which majority (89%) of the injuries occurred to boys aged 15-24. The injuries were aggregated by three age groups (0-4, 5-14, and 15-24), 20 health regions (based of place-of-residence), and 10 calendar years (1987 to 1996) and the corresponding mid-year population estimates were used as 'at risk' population. An empirical Bayes inference technique using penalised quasi-likelihood estimation was implemented to model both rates and counts, with spline smoothing accommodating non-linear temporal effects. The results show that (a) crude rates and ratios at health region level are unstable, (b) the models with spline smoothing enable us to explore possible shapes of injury trends at both the provincial level and the regional level, and (c) the fitted models provide a wealth of information about the patterns (both over space and time) of the injury counts, rates and ratios. During the 10-year period, high injury risk ratios evolved from northwest to central-interior and the southeast [corrected].     

Statistical adjustment for misclassification of seat belt and alcohol use in the analysis of motor vehicle accident data

The use of seat belts and alcohol is often mis-reported in police motor vehicle accident reports for a number of reasons. To avoid penalties, occupants often over report seat belt use and under report alcohol use. Police officers sometimes fail to account for evidence such as presence of belt burn, condition of belts, odor of alcohol, crash patterns, etc. Biased conclusions result when using misclassified accident data to estimate the effectiveness of seat belts in preventing injuries and reducing medical costs. We investigated the effects of misclassification of seat belt and alcohol use on the odds ratio of injury as well as medical costs. A statistical method and a SAS program were developed to adjust odds ratios of injury and medical cost estimates to account for misclassification of seat belts and alcohol use. The method allowed for incorporation of variables that could affect misclassification of seat belt and alcohol use. We conducted a Monte Carlo simulation and found that when there were large differences between the misclassification rates for major and minor injury, the unadjusted odds ratio could have up to a 90% bias while our adjusted odds ratio was effectively unbiased. To illustrate the method, we estimated the misclassification rates of seat belt and alcohol use by comparing merged police and hospital reports from Nebraska motor vehicle accident data sets (1996-1997) and then evaluated the bias of the odds ratio of injury and medical costs estimates due to misclassification. Our results showed that the bias of the odds ratio of injury and medical costs due to misclassification of seat belts and alcohol use depended both on the amount of misclassification and the reported frequencies. Misclassification about seat belt and alcohol use only slightly biased the unadjusted odds ratio estimates and mean hospital charge, while misclassification resulted in approximately a 69% underestimate of the total medical costs savings due to seatbelts. However, due to the small size of the merged Nebraska police and hospital data set used to estimate misclassification rates, these results are likely somewhat imprecise.